Singh Neeta, Begum Anjuman Ara, Malhotra Neena, Bahadur Anupama, Vanamail P
Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
J Hum Reprod Sci. 2013 Jul;6(3):213-8. doi: 10.4103/0974-1208.121425.
This study was performed to assess the prognostic value of serum beta human chorionic gonadotropin (βhCG), measured on day 14 post embryo transfer (ET) for predicting multiple gestation and pregnancy wastage in women undergoing in vitro fertilization ET (IVF-ET).
This retrospective study was performed between May 2009 and November 2012. Out of the 181 women who conceived, 168 were included and the remaining 13 were excluded as their pregnancy was biochemical. Serum βhCG was measured using a chemiluminescent enzyme immunometric assay. The predictive values of serum βhCG for establishing multiple pregnancy and pregnancy wastages were calculated by receiver operating characteristic (ROC) curve analysis. Median values of serum βhCG and outcome of all pregnancies were compared.
Out of the 168 patients who conceived after IVF treatment, 114 (68%) were viable pregnancies (delivered/ongoing). Among the viable pregnancies, 97 (85%) had a successful pregnancy outcome and the remaining 17 patients are ongoing pregnancies. Median values of βhCG (625 IU/L) among viable pregnancies was significantly (P < 0.05) higher than that of nonviable pregnancies (174 IU/L). The median values of βhCG for singleton (502 IU/L), twins (1093 IU/L), and triplets (2160 IU/L) was statistically significant (P < 0.05). Using ROC curve it was predicted that for a value of βhCG at 375 IU/L, the sensitivity of viable pregnancy was 65% and specificity of viable pregnancy was also 65%, with positive and negative predictive values of 65 and 68%, respectively. Similarly for multiple pregnancy and pregnancy wastage the predictive values of βhCG were 808 and 375 IU/L, respectively; while the sensitivity and specificity is more than 65% each.
βhCG cutoff values determined on day 14 post ET by ROC curve analysis are useful in discriminating between multiple pregnancy and pregnancy losses. The cutoff value might aid in the prognosis, clinical management, and counseling of the IVF patients.
本研究旨在评估胚胎移植（ET）后第14天测量的血清β人绒毛膜促性腺激素（βhCG）对预测接受体外受精胚胎移植（IVF-ET）的女性多胎妊娠和妊娠丢失的预后价值。
本回顾性研究于2009年5月至2012年11月进行。在181名受孕女性中，纳入了168名，其余13名因妊娠为生化妊娠而被排除。采用化学发光酶免疫分析法测定血清βhCG。通过受试者操作特征（ROC）曲线分析计算血清βhCG对确定多胎妊娠和妊娠丢失的预测价值。比较血清βhCG的中位数和所有妊娠的结局。
在168名接受IVF治疗后受孕的患者中，114名（68%）为活产妊娠（分娩/持续妊娠）。在活产妊娠中，97名（85%）有成功的妊娠结局，其余17名患者为持续妊娠。活产妊娠中βhCG的中位数（625 IU/L）显著高于非活产妊娠（174 IU/L）（P<0.05）。单胎（502 IU/L）、双胎（1093 IU/L）和三胎（2160 IU/L）的βhCG中位数具有统计学意义（P<0.05）。使用ROC曲线预测，当βhCG值为375 IU/L时，活产妊娠的敏感性为65%，特异性也为65%，阳性和阴性预测值分别为65%和68%。同样，对于多胎妊娠和妊娠丢失，βhCG的预测值分别为808和375 IU/L；而敏感性和特异性均超过65%。
通过ROC曲线分析确定的ET后第14天的βhCG临界值有助于区分多胎妊娠和妊娠丢失。该临界值可能有助于IVF患者的预后、临床管理和咨询。
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